Scheme eases load on hospital

SARAH DUNN
Last updated 13:00 28/12/2013

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A social worker and two physiotherapists working on a pilot project have slotted right into Nelson Hospital's emergency department.

Social worker Debbie Hollebon and physiotherapists Alice Scranney and Clare Holmes form the Allied Health Team. The team first started work in the fast-paced emergency department last year as part of an experimental project aimed at reducing the length of stays in hospital, preventing admissions to hospital, reducing the frequency of "frequent presenters" to the emergency department, and generally smoothing the road for patients and staff.

The team won the Nelson Marlborough District Health Board's in-house Health Quality and Innovation Awards this year, receiving $1150 in prize money and a large trophy.

Chief executive Chris Fleming said the Allied Health team was leading the country with its work, saying all clinicians would benefit from learning about it.

Ms Hollebon said she worked by following up on referrals made by nurses who were concerned about patients. A common scenario included a patient who lived alone and was being discharged to an empty house after an illness.

In this case, she said she would arrange for a follow-up visit to be made with support available, or request specific assistance with meals or showering.

"It's in the best interests of [patients] to be kept at home where possible," she said.

If nurses noted any concerns involving children while they were treating patients, Ms Hollebon said she would go and check it out. Signs of poverty, family violence or a chaotic household could all raise red flags, but occasionally, a patient could also confide in a nurse about somebody close to them.

"Often, clinicians are focusing on the person with the problem, but if I get a whiff that there are children involved, I'll follow up to see that those children are safe."

Ms Hollebon said poverty was the most common problem she saw. It was far from abnormal for Nelson residents to come to the emergency department with sore teeth in lieu of paying for a dentist's appointment privately.

"People only need a few extra bills and then a bad toothache . . . Most people can't afford a dentist just at the drop of a hat."

Homelessness, non-critical alcohol and drug dependencies and mental health issues also took up her time, as did supporting families when there was a bereavement. She put together management plans to help people who came to the emergency department frequently so that they were treated by the same staff every time they came in.

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Ms Scranney said a physiotherapist's role was much more widely applicable than the public generally understood.

In the emergency department, she and Ms Holmes were able to pick some patients out of the waiting room and treat them instead of the doctor, so that doctors were able to focus on more serious cases.

She could handle most people with musculo-skeletal injuries, particularly those with sore backs. Ankle sprains, wrist and hand injuries and respiratory concerns also fell under her expertise.

"Really, it's about us dealing with the ones that aren't so sick and that leaves them to concentrate on the ones that are critically ill."

Ms Hollebon said she and the physiotherapists' work took pressure off the nurses, who formerly had to follow up on patients themselves.

"They can sleep at night now, knowing their patients are being taken care of with follow-ups."

- © Fairfax NZ News

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